If there's anyone who would notice an additional fee being tacked on to their doctor bill, it would be Julie Teichman.
A former medical insurance professional who got her start in the industry in 1991, Teichman says she knows "pretty much the ins-and-outs" of all the fine print on medical bills.
That's why, when she noticed something new earlier this year after checking her insurance information, the Normal resident was surprised.
"There were two charges on the same day and I was like, 'What is that?' So I had to call the insurance company and ask them and that's when they told that it was a facility charge," Teichman said. "I'm like, 'What is that?' Because I'd never heard of that."
Teichman called her health care provider's billing department for answers, but still left the conversation perplexed.
She learned that visits to a certain facility within the health care provider's network of sites would always garner a $50 facility fee, a charge meant to cover the cost of providing care and related supplies.
Teichman said she was further told it could cover medical supplies used during visits.
"What did I first think of that? I thought it was a sham. I think it's ridiculous they have to charge that fee," she said. "You're already getting enough money from your patients."
In Bloomington-Normal, both of the primary health care providers in town charge facility fees: Carle Health and OSF Healthcare.
A spokesperson for Carle Health said some clinics were reclassified as outpatient clinics of the hospital in 2021 and 2022.
OSF Healthcare said in a statement it charges facility fees for some "sub-specialty" services at its St. Joseph Medical Center, as well as "services customarily delivered by hospitals for inpatient and outpatient procedural, diagnostic and treatment services."
What are facility fees?
Put simply, facility fees are flat rate fees added to a patient's bill to cover the cost of providing health care.
Or, as U.S. Public Research Interest Group health care advocate Maribeth Guarino puts it, they're "flat charges that are added to a patient's bill, generally just for stepping in the door."
Guarino recently authored a report for the federation of U.S. and Canada-based nonprofits that focused on the growing prevalence of facility fees — though for some health care groups the practice dates back to 2009.
"In other locations, though, like in your clinics, in your doctor's offices on Main Street, those [charges] are newer," Guarino said. "Those are happening because hospitals are buying up these practices and treating them as hospital locations — even though they're two miles up the road from the actual hospital itself."
The report points to market consolidation as the primary driver for charging facility fees: It's expensive to provide health care, so with concentrated market power, health care groups may charge facility fees — simply because they can.
"I have heard the same talking points over and over again: It's inflation. It's the cost of owning the land or buying a new X-ray or MRI machine or whatever other special equipment," Guarino said. "Hospital finances are very complicated... Depending on the angle you take, it's hard to say whether those fees are what's helping to pay down those expenses or whether or not it's just adding to revenue."
The Illinois Health and Hospital Association, a network of 200 hospitals and 40 healthcare groups through the state, has not yet responded to a request for comment on the fees.
Will insurance cover the fee?
Perhaps the primary point of tension surrounding fees is whether the patient is ultimately stuck with the bill.
Sometimes insurance companies won't pick up the cost, leaving the patient to pay it on top of other, expected costs like co-pays, putting the sticker price of a doctor visit that much higher.
"On occasion, insurance companies will cover it and it's part of your your insurance coverage. But frequently, they're not even covered by insurance," Guarino said of her report findings.
Though troubled by the existence of the fee itself, Teichman said her insurance did end up covering the fee.
But no matter who pays it, Guarino said the extra expense eventually will make its way back into the consumer's wallet.
"Regardless, these extra charges are then raising potentially premiums because insurance companies are paying more — so they're passing those costs off to consumers and patients in the form of raised premiums," she said. "At the end of the day, patients bear the brunt of that burden."
What can consumers do?
As an advocacy group, U.S. PIRG has signaled its support of various pieces of state legislation across the country that regulate facility fees to varying extents — though Illinois is not among them.
Some states have outright banned such fees [including Texas, Colorado, New York and others] while other states, like Indiana, have passed bills that require various transparency measures from hospital and health care groups that do charge the fees.
U.S. PIRG also is currently pushing the Federal Trade Commission [FTC] to include facility fees in its proposal to ban junk fees nationwide.
And last month, the Biden administration proposed an outright ban on "unwarranted" facility fees in telehealth and "certain outpatient services."
But in the absence of legislation like that in Illinois, both Gaurino and Teichman said there are things consumers can do to advocate for themselves.
There is always, of course, asking one's provider directly for information: Even for patients who are underinsured or not insured, there's a requirement for providers to draft a good faith estimate of what a patient's bill will be for a scheduled service — which should include the fee.
"And if your bill when you get it is $400 or more higher than the estimate, you have a really good chance at fighting that bill," she said. "These facility fees can be $15, but they can also be thousands of dollars. So that $400 difference could be really significant."
For Teichman, it all goes back to the fine print.
"People need to look at their bills. They need to question anything that they have any questions about. They should learn how to read an EOB [explanation of benefits]," she said. "Don't just settle for it if you're not comfortable with it."
